Name:*

Email:*

1. Your location:*

2. How did you find out about me:*

Maxfisch.com
MistressDubai.com
Hogspy.com
DickieVirgin.com
Google
Backpage
Twitter, Instagram, Tumblr
Other

3. Your availability (specific dates & times):*

4. Session duration:*

1 hour
1.5 hours
2 hours
2.5 hours
3 hours
4 hours
The Romanovich Special
The Overnight Thrill
A Day
A Weekend
A Trip Away

5. What do you consider yourself the most?*

Submissive
Slave
Masochist
Fetishist
Kinky

6. What is your level of experience?*

No prior experience
Some experience
Experienced
Very experienced

7. Provide a name & email address of one previous Mistress so I can check your references (Please note that if you have no prior experience and cannot provide references, you will be required to make a 50% deposit for the session):*

8. Your interests and prefered activities:

9. Pain level:*

No pain
Light
Medium
Heavy
Extreme

10. Preferred session tone:*

Strict
Sensual
Sadistic
Between sadistic and sensual
Arrogant/Bitchy
Playful

11. Preferred Mistress attire:*

Leather
Latex
Lingerie
PVC
Business attire
Uniform
Casual
No preferences

12. Any additional comments: